- Repealing the termination date for certain provisions related to referrals and reimbursement of specialists and nonphysician specialists not part of a carrier's provider panel.
- Requiring carriers to provide assistance in identifying and arranging coverage for mental health or substance use disorder services by nonparticipating providers.
- Prohibiting prior authorization requirements for scheduling, reimbursing, or continuing treatment with nonparticipating providers.
- Establishing reimbursement rates for nonparticipating providers by the Maryland Health Care Commission.

The act is set to take effect on June 1, 2025, with certain sections taking effect on January 1, 2026.

- Altering definitions in the Insurance Article to conform to federal regulations.
- Ensuring that hospital indemnity or other fixed indemnity insurance coverage qualifies for exceptions described in federal regulations.

The act is set to take effect on October 1, 2025.

- Renaming the program to the State-Based Young Adult Health Insurance Subsidies Program.
- Repealing the termination date of certain provisions of law that establish and govern the funding for the program.
- Ensuring the program continues to provide subsidies to young adults for the purchase of health benefit plans in the individual health insurance market.

The act is set to take effect on July 1, 2025.

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House Bill 321, titled "Pharmacy Benefits Managers - Definition of Purchaser and Alteration of Application of Law," proposes changes to the definition of "purchaser" and the application of certain provisions of state insurance law governing pharmacy benefits managers in Maryland. Key provisions include:

- Altering the definition of "purchaser" to exclude certain nonprofit health maintenance organizations.
- Repealing provisions that restrict the applicability of certain laws to pharmacy benefits managers providing services on behalf of a carrier.

The act is set to take effect on January 1, 2026.

- Altering the definition of "purchaser" to exclude certain nonprofit health maintenance organizations.
- Repealing provisions that restrict the applicability of certain laws to pharmacy benefits managers providing services on behalf of a carrier.

The act is set to take effect on January 1, 2026.

- Establishing that any provision in a consumer contract that sets a shorter period of time to bring an action than required under state law is void.
- Providing that a violation of this act is considered a violation of the Consumer Protection Act.
- Applying the act prospectively to contracts entered into after the effective date of the act.

The act is set to take effect on October 1, 2025.

- Requiring carriers to post updated, accurate, and complete formularies on their websites.
- Ensuring that generic drugs and biosimilars are available on formularies with favorable cost-sharing compared to their reference drugs.
- Prohibiting carriers from imposing prior authorization or step therapy requirements on generic drugs and biosimilars added to formularies.
- Mandating carriers to inform enrollees of changes to formularies within 30 days.

The act is set to take effect on January 1, 2026.

- Altering the exemption criteria for individuals employed in an administrative, executive, or professional capacity.
- Specifying salary and fee basis requirements for these exemptions.
- Defining primary duties and responsibilities for exempt employees, including management, discretion, and independent judgment.

The act is set to take effect on October 1, 2025.

- Prohibiting certain carriers from imposing prior authorization, step therapy, or quantity limit requirements on eligible providers for health care services included in a two-sided incentive arrangement.
- Defining "eligible provider" and "two-sided incentive arrangement."
- Requiring carriers to disclose certain payment information to eligible providers.
- Applying the act to all policies, contracts, and health benefit plans issued, delivered, or renewed in the state on or after January 1, 2026.

The act is set to take effect on January 1, 2026.

The duties of the commission include (1) assessing the current and potential adverse effects of the loss of health coverage on the residents, public health, and economy of the State resulting from changes to the ACA, MHPAEA, Medicaid, MCHP, Medicare, or the Maryland All-Payer Model; (2) estimating the costs of such adverse effects and the resulting loss of health coverage; (3) examining measures that may prevent or mitigate such adverse effects and the resulting loss of health coverage; (4) making recommendations for laws that may be warranted to minimize such adverse effects and will assist residents in obtaining and maintaining affordable health coverage; and (5) identifying potential funding sources for recommended laws, as necessary. The commission may hold public meetings across the State to carry out its duties and convene workgroups to solicit input from stakeholders. The 25-member commission consists of (1) three members of the Senate; (2) three members of the House of Delegates; (3) the Secretary of Health (or designee); (4) the Maryland Insurance Commissioner (or designee); (5) the Executive Director of the Health Services Cost Review Commission (or designee); (6) the Executive Director of the Maryland Health Benefit Exchange (or designee); (7) the Attorney General (or designee); (8) one representative of the Maryland Hospital Association; (9) one representative of a managed care organization; (10) one consumer of health care services; (11) one representative of a health insurance carrier; (12) one representative who is an employer; (13) one representative of the nursing home industry; (14) one representative of MedChi; (15) one representative of behavioral health care providers; (16) two members of the public; (17) one representative of a group model health maintenance organization (HMO); (18) one representative of the League of Life and Health Insurers of Maryland; (19) one representative of the National Association of Insurance and Financial Advisors; and (20) one representative of the Maryland Association of Counties. The President and the Speaker must designate a member who is a senator and a member who is a delegate, respectively, to serve as co-chairs of the commission. Members of the commission may not receive compensation but are entitled to reimbursement for expenses, as provided in the State budget.

2/8 Chris Farmer wants an amendment to include a member of NAIFA-MD.

House Bill 718, titled "Maryland Health Insurance Coverage Protection Commission - Established," proposes the establishment of a commission to monitor and assess the impact of potential and actual federal changes to specified health care programs. Key provisions include:

- Establishing the Maryland Health Insurance Coverage Protection Commission.
- Monitoring potential and actual federal changes to the ACA, Medicaid, the Maryland Children's Health Program, Medicare, and the Maryland All-Payer Model.
- Assessing the impact of these changes on Maryland residents' access to affordable health coverage.
- Providing recommendations for state and local action to protect residents' access to affordable health coverage.
- Submitting annual reports on findings and recommendations to the Governor and General Assembly.

The act is set to take effect on June 1, 2025, and will remain effective until June 30, 2029.

- Requiring carriers, pharmacy benefits managers, and private review agents to ensure that AI, algorithms, or other software tools are used appropriately in utilization review.
- Ensuring AI tools base their determinations on an enrollee's medical or clinical history, individual clinical circumstances, or other relevant clinical information.
- Prohibiting AI tools from making determinations solely based on group datasets.
- Ensuring AI tools do not replace the role of healthcare providers in the determination process.
- Prohibiting discrimination against enrollees by AI tools.
- Requiring AI tools to be open to inspection for audit or compliance reviews.
- Prohibiting AI tools from denying, delaying, or modifying healthcare services.

The act is set to take effect on October 1, 2025.

“Genetic test” means an analysis of human DNA, RNA, chromosomes, proteins, or metabolites that detects genotypes, mutations, or chromosomal changes.

An insurer that offers, issues, or delivers a life insurance or disability insurance policy or contract in the State may not unfairly discriminate against an individual by conditioning insurance rates, the provision or renewal of insurance coverage, or other conditions of insurance based on medical information, including the results of a genetic test for which there is not a relationship between the medical information and the cost of the insurance risk that the insurer would assume by insuring the applicant. Nevertheless, to demonstrate a relationship between the medical information and cost of insurance risk assumed by insuring the applicant, an insurer may rely on actuarially sound principles or actual or reasonably anticipated experience. Additionally, an insurer that offers, issues, or delivers a life insurance or disability insurance policy or contract in the State may not access sensitive medical information, including genetic data of an individual, without first obtaining the individual's signed, written consent. Further, an insurer may never mandate existing or new genetic testing or full genome sequencing as a prerequisite for life insurance or disability insurance eligibility or coverage; moreover, an insurance carrier, applicant, or policy contract holder may not waive this prohibition under any circumstances. The bill expressly authorizes the Insurance Commissioner to issue an order for a violation of the bill using the Commissioner's existing enforcement powers that allow the Commissioner to (1) deny, refuse to renew, suspend, and revoke an insurer's certificate of authority; (2) impose a civil penalty in lieu of suspending or revoking a certificate of authority; (3) send and enforce cease and desist orders; and (4) order an insurer to accept a risk.

In the past we have not submitted testimony and left it to the carriers to fight. Brett sent email to committee on 2/9 asking what we want to do. After speaking with NAIFA National it was decided not to take a position on this bill.

2/9 Brett sent email asking for feedback. Jolles feedback:

The bill appears to seek to restrict certain clauses—specifically discretionary clauses—in insurance to retain. The intent behind the bill appears to be increasing transparency and consumer protection by limiting a carrier's ability to control the interpretation of terms that could affect claims decisions. While this can help prevent unfair practices or hidden barriers for consumers, there are legitimate concerns that removing these clauses could unintentionally harm the competitive landscape and the availability of coverage.

By removing discretion in interpreting policy terms, the bill could limit insurers' flexibility in managing risk. Without discretionary clauses, insurers may face greater uncertainty in underwriting, which could prompt them to scale back their participation in certain markets. The reduced flexibility could, in turn, impact both the variety and cost of policies available to consumers.

Purpose: Prohibit Discretionary Clauses: Disallow discretionary clauses in life insurance policies, health insurance policies, and annuity contracts. Key Provisions: Insurance Policies: Ban clauses that reserve sole discretion to the insurer to interpret policy terms or provide standards of interpretation or review. Health Maintenance Organizations: Apply the prohibition to health maintenance organizations. Effective Date: October 1, 2025 Implementation Date for Policies: January 1, 2026

Key Provisions:

1. Maryland Health Benefit Exchange Fund:

   • Section 31-107 (Page 2-5): Establishes the Maryland Health Benefit Exchange Fund to support various health programs, including the new State-Based Health Insurance Subsidies Program.

2. State-Based Health Insurance Subsidies Program:

   • Section 31-125 (Page 6-7): Mandates the creation of a program to provide subsidies to individuals purchasing health insurance in the individual market, particularly to mitigate the impact of reduced federal advance premium tax credits.

3. Program Design and Implementation:

   • Section 31-125(c) (Page 7): The program must maintain affordability and target individuals affected by increased premium percentages in 2026 and 2027 compared to 2025.

4. Funding and Expenditures:

   • Section 31-107(f) (Page 4-5): Specifies that the fund can be used for the new subsidies program in fiscal years 2026 through 2028.

5. Contingency and Effective Dates:

   • Section 2 (Page 8): The act is contingent on the federal government reducing or eliminating advance premium tax credits, with specific conditions for notification and implementation.

Effective Date:

• General Provisions: Effective June 1, 2025, and remains in effect until June 30, 2028, subject to the conditions outlined in Section 2.

Purpose: State-Based Health Insurance Subsidies: Establish subsidies to mitigate the impact of reduced federal advance premium tax credits. Key Provisions: Program Implementation: Maryland Health Benefit Exchange to implement the program. Provide funding from the Maryland Health Benefit Exchange Fund. Consumer Protections: Maintain affordability for individuals purchasing health benefit plans. Target individuals experiencing increased premium percentages in 2026 compared to 2025. Funding and Expenditures: Use the Maryland Health Benefit Exchange Fund for subsidies in fiscal years 2026 and 2027. Reporting and Tracking: Monthly Tracking: Track expenditures, average number of subsidy recipients, average subsidy amounts, and impact on rates. Post tracking information on the Exchange website and include it in the annual report. Effective Date: July 1, 2025

2/7 Committee discussed it and will revisit the discussion on 2/21 for final position.

2/21 Submitted testimony FWA to add guardrails and sunset to the bill.

- Renaming the program to the State-Based Young Adult Health Insurance Subsidies Program.
- Repealing the termination date of certain provisions of law that establish and govern the funding for the program.
- Authorizing, rather than requiring, the Maryland Health Benefit Exchange to establish and implement the program.
- Prohibiting the Exchange from implementing the program if certain funds are not available.

The act is set to take effect on July 1, 2025.

Senate Bill 41, titled "Maryland Small Business Retirement Savings Board - Membership - Alteration," proposes changes to the membership of the Maryland Small Business Retirement Savings Board. Key provisions include:

- Adding the Comptroller, or the Comptroller's designee, as a member of the Board.
- Ensuring the Board consists of the State Treasurer, the Secretary of Labor, the Comptroller, and nine members with expertise in retirement programs, investments, financial systems, or small business.

The act is set to take effect on October 1, 2025.

- Altering definitions in the Insurance Article to conform to federal regulations.
- Ensuring that hospital indemnity or other fixed indemnity insurance coverage qualifies for exceptions described in federal regulations.

The act is set to take effect on October 1, 2025.

- Altering the definition of "purchaser" to exclude certain nonprofit health maintenance organizations.
- Repealing provisions that restrict the applicability of certain laws to pharmacy benefits managers providing services on behalf of a carrier.

The act is set to take effect on January 1, 2026.

- Delaying the start date for employee, employer, and self-employed contributions to the Fund from July 1, 2025, to July 1, 2027.
- Delaying the start date for the payment of benefits from July 1, 2026, to July 1, 2028.
- Adjusting the timeline for setting contribution rates and conducting cost analyses accordingly.

The act is set to take effect on October 1, 2025.

- Requiring health insurers, nonprofit health service plans, and health maintenance organizations to provide coverage for preventive cancer screenings for professional firefighters.
- Prohibiting copayments, coinsurance, or deductible requirements for these screenings, except for high-deductible health plans.
- Ensuring compliance by counties, municipalities, and the State Employee and Retiree Health and Welfare Benefits Program.

The act is set to take effect on January 1, 2026.

- Requiring carriers to post updated, accurate, and complete formularies on their websites.
- Ensuring that generic drugs and biosimilars are available on formularies with favorable cost-sharing compared to their reference drugs.
- Prohibiting carriers from imposing prior authorization or step therapy requirements on generic drugs and biosimilars added to formularies.
- Mandating carriers to inform enrollees of changes to formularies within 30 days.

The act is set to take effect on January 1, 2026.

- Increasing the maximum subtraction modification for contributions to the Maryland Senator Edward J. Kasemeyer Prepaid College Trust account, Maryland Senator Edward J. Kasemeyer College Investment Plan, or Broker-Dealer College Investment Plan.
- Setting the new maximum subtraction modification at $4,850 for taxable years beginning after December 31, 2025.
- Allowing any disallowed subtraction to be carried over to succeeding taxable years until the full amount of the advance payments has been allowed as a subtraction.

The act is set to take effect on July 1, 2025.

- Prohibiting consumer contracts from setting a shorter time to bring an action than required by state law.
- Declaring such provisions against state public policy, illegal, and void.
- Ensuring courts do not enforce these provisions and that they cannot be used as a defense to liability.

The act is set to take effect on October 1, 2025.

- Prohibiting certain carriers from imposing prior authorization, step therapy, or quantity limit requirements on eligible providers for health care services included in a two-sided incentive arrangement.
- Defining "eligible provider" and "two-sided incentive arrangement."
- Applying the act to all policies, contracts, and health benefit plans issued, delivered, or renewed in the state on or after January 1, 2026.

The act is set to take effect on January 1, 2026.

- Requiring insurers, nonprofit health service plans, and health maintenance organizations to provide coverage for preventive screenings for ovarian cancer for individuals at least 45 years old.
- Including magnetic resonance imaging (MRI) and computed tomography (CT) scans in the required coverage.
- Prohibiting copayments, coinsurance, or deductible requirements for these screenings, except for high-deductible health plans.

The act is set to take effect on January 1, 2026.

This bill passed into the House and has a hearing date of 3/27. It is not crossfiled.

Senate Bill 956 requires carriers to pay brokers the same commission rate for selling Medicare supplement policies during a guaranteed issue period as they do during an open enrollment period. The act is set to take effect on October 1, 2025.

Senate Bill 961 requires the Maryland Medical Assistance Program and certain health insurers to provide coverage for single-gene and multigene pharmacogenomic testing under specified conditions. The bill also limits the prior authorization requirements that health insurers may implement for such testing. The act is set to take effect on October 1, 2025.